Paycheck Protection Program: Loan Forgiveness Application ...

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

Paycheck Protection Program

Loan Forgiveness Application Form 3508 Revised January 19, 2021

PPP Loan Forgiveness Calculation Form

Business Legal Name (¡°Borrower¡±)

Business Address

DBA or Tradename, if applicable

NAICS Code

Business TIN (EIN, SSN)

Primary Contact

(

)

Business Phone

-

E-mail Address

? First Draw PPP Loan ? Second Draw PPP Loan (check one)

SBA PPP Loan Number:

Lender PPP Loan Number:

PPP Loan Amount:

PPP Loan Disbursement Date:

Employees at Time of Loan Application:

Employees at Time of Forgiveness Application:

Covered Period:

to

If Borrower (Together with Affiliates, if Applicable) Received First Draw PPP Loans of $2 Million or More or Second Draw

PPP Loans of $2 Million or More, check here: ?

Forgiveness Amount Calculation:

Payroll and Nonpayroll Costs

Line 1. Payroll Costs (enter the amount from PPP Schedule A, line 10):

Line 2. Business Mortgage Interest Payments:

Line 3. Business Rent or Lease Payments:

Line 4. Business Utility Payments:

_____________________

Line 5. Covered Operations Expenditures:

_____________________

Line 6. Covered Property Damage Costs:

_____________________

Line 7. Covered Supplier Costs:

_____________________

Line 8. Covered Worker Protection Expenditures:

_____________________

Adjustments for Full-Time Equivalency (FTE) and Salary/Hourly Wage Reductions

Line 9. Total Salary/Hourly Wage Reduction (enter the amount from PPP Schedule A, line3):

Line 10. Sum the amounts on lines 1 through 8, then subtract the amount entered in line 9:

Line 11. FTE Reduction Quotient (enter the number from PPP Schedule A, line13):

Potential Forgiveness Amounts

Line 12. Modified Total (multiply line 10 by line 11):

Line 13. PPP Loan Amount:

Line 14. Payroll Cost 60% Requirement (divide line 1 by 0.60):

Forgiveness Amount

Line 15. Forgiveness Amount (enter the smallest of lines 12, 13, and 14):

SBA Form 3508 (01/21)

Page 1

Paycheck Protection Program

Loan Forgiveness Application Form 3508 Revised January 19, 2021

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

By Signing Below, You Make the Following Representations and Certifications on Behalf of the Borrower:

The authorized representative of the Borrower certifies to all of the below by initialing next to each one.

The dollar amount for which forgiveness is requested (which does not exceed the principal amount of the PPP loan):

? was used to pay business costs that are eligible for forgiveness (payroll costs to retain employees; business

mortgage interest payments; business rent or lease payments; business utility payments; covered operations

expenditures; covered property damage costs; covered supplier costs; or covered worker protection expenditures);

? includes all applicable reductions due to decreases in the number of full-time equivalent employees and

salary/hourly wage reductions;

? includes payroll costs equal to at least 60% of the forgiveness amount;

? for any owner-employee (with an ownership stake of 5% or more) or self-employed individual/general partner,

does not exceed 2.5 months¡¯ worth of compensation received during the year used to calculate the PPP loan

amount, capped at $20,833 per individual in total across all businesses.

I understand that if the funds were knowingly used for unauthorized purposes, the federal government may pursue recovery

of loan amounts and/or civil or criminal fraud charges.

The Borrower has accurately verified the payments for the eligible payroll and nonpayroll costs for which the Borrower is

requesting forgiveness.

I have submitted to the Lender the required documentation verifying payroll costs, the existence of obligations and service

(as applicable) prior to February 15, 2020, and eligible business mortgage interest payments, business rent or lease

payments, business utility payments, covered operations expenditures, covered property damage costs, covered supplier

costs, and covered worker protection expenditures.

_______ If this application is being submitted for a Second Draw PPP Loan, the Borrower used all First Draw PPP Loan amounts

on eligible expenses prior to disbursement of the Second Draw PPP Loan.

The information provided in this application and the information provided in all supporting documents and forms is true

and correct in all material respects. I understand that knowingly making a false statement to obtain forgiveness of an

SBA-guaranteed loan is punishable under the law, including 18 U.S.C. 1001 and 3571 by imprisonment of not more than

five years and/or a fine of up to $250,000; under 15 U.S.C. 645 by imprisonment of not more than two years and/or a fine

of not more than $5,000; and, if submitted to a Federally insured institution, under 18 U.S.C. 1014 by imprisonment of not

more than thirty years and/or a fine of not more than $1,000,000.

The tax documents I have submitted to the Lender (if applicable) are consistent with those the Borrower has

submitted/will submit to the IRS and/or state tax or workforce agency. I also understand, acknowledge, and agree that

the Lender can share the tax information with SBA¡¯s authorized representatives, including authorized representatives

of the SBA Office of Inspector General, for the purpose of ensuring compliance with PPP requirements and all SBA

reviews.

I understand, acknowledge, and agree that SBA may request additional information for the purposes of evaluating the

Borrower¡¯s eligibility for the PPP loan and for loan forgiveness, and that the Borrower¡¯s failure to provide information

requested by SBA may result in a determination that the Borrower was ineligible for the PPP loan or a denial of the

Borrower¡¯s loan forgiveness application.

_____

If the Borrower has checked the box for FTE Reduction Safe Harbor 1 on PPP Schedule A, the Borrower was unable

to operate between February 15, 2020 and the end of the Covered Period at the same level of business activity as

before February 15, 2020 due to compliance with requirements established or guidance issued between March 1, 2020

and December 31, 2020 (or, for a PPP loan made after December 27, 2020, requirements established or guidance issued

between March 1, 2020 and the last day of the Covered Period), by the Secretary of Health and Human Services, the Director

of the Centers for Disease Control and Prevention, or the Occupational Safety and Health Administration, related to the

maintenance of standards of sanitation, social distancing, or any other work or customer safety requirement related to

COVID-19.

The Borrower¡¯s eligibility for loan forgiveness will be evaluated in accordance with the PPP regulations and guidance issued by SBA

through the date of this application. SBA may direct a lender to disapprove the Borrower¡¯s loan forgiveness application if SBA

determines that the Borrower was ineligible for the PPP loan.

_____________________________________________________

Signature of Authorized Representative of Borrower

____________________________

Date

_____________________________________________________

Print Name

____________________________

Title

SBA Form 3508 (01/21)

Page 2

Paycheck Protection Program

Loan Forgiveness Application Form 3508 Revised January 19, 2021

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

PPP Schedule A

PPP Schedule A Worksheet, Table 1 Totals

Line 1. Enter Cash Compensation (Box 1) from PPP Schedule A Worksheet, Table 1:

Line 2. Enter Average FTE (Box 2) from PPP Schedule A Worksheet, Table 1:

Line 3. Enter Salary/Hourly Wage Reduction (Box 3) from PPP Schedule A Worksheet, Table 1:

If the average annual salary or hourly wage for each employee listed on the PPP

Schedule A Worksheet, Table 1 during the Covered Period was at least 75% of such

employee¡¯s average annual salary or hourly wage for the most recent full quarter before

the Covered Period, check here ? and enter 0 on line 3.

PPP Schedule A Worksheet, Table 2 Totals

Line 4. Enter Cash Compensation (Box 4) from PPP Schedule A Worksheet, Table 2:

Line 5. Enter Average FTE (Box 5) from PPP Schedule A Worksheet, Table 2:

Non-Cash Compensation Payroll Costs During the Covered Period

Line 6. Total amount paid or incurred by Borrower for employer contributions for employee insurance:

Line 7. Total amount paid or incurred by Borrower for employer contributions to employee retirementplans:

Line 8. Total amount paid or incurred by Borrower for employer state and local taxes assessed on

employee compensation:

Compensation to Owners

Line 9. Total amount paid to owner-employees/self-employed individual/general partners:

This amount may not be included in PPP Schedule A Worksheet, Table 1 or 2. If there is

more than one individual included, attach a separate table that lists the names of and

payments to each.

Total Payroll Costs

Line 10. Payroll Costs (add lines 1, 4, 6, 7, 8, and 9):

Full-Time Equivalency (FTE) Reduction Calculation

If you satisfy any of the following three criteria, check the appropriate box, skip lines 11 and 12, and enter 1.0 on line 13; otherwise,

complete lines 11, 12, and 13:

No reduction in employees or average paid hours: If you have not reduced the number of employees or the average paid hours of

your employees between January 1, 2020 and the end of the Covered Period, check here ?.

FTE Reduction Safe Harbor 1: If you were unable to operate between February 15, 2020, and the end of the Covered Period at the

same level of business activity as before February 15, 2020 due to compliance with requirements established or guidance issued

between March 1, 2020 and December 31, 2020 (or, with respect to a PPP loan made on or after December 27, 2020, between March 1,

2020 and the last day of the Covered Period with respect to such loan), by the Secretary of Health and Human Services, the Director of

the Centers for Disease Control and Prevention, or the Occupational Safety and Health Administration related to the maintenance of

standards for sanitation, social distancing, or any other worker or customer safety requirement related to COVID-19, check here ?.

FTE Reduction Safe Harbor 2: If you satisfy FTE Reduction Safe Harbor 2 (see PPP Schedule A Worksheet), check here ?.

Line 11. Average FTE during the Borrower¡¯s chosen reference period:

Line 12. Total Average FTE (add lines 2 and 5):

Line 13. FTE Reduction Quotient (divide line 12 by line 11) or enter 1.0 if any of the above criteria aremet:___________________

SBA Form 3508 (01/21)

Page 3

Paycheck Protection Program

Loan Forgiveness Application Form 3508 Revised January 19, 2021

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

PPP Schedule A Worksheet

Table 1: List employees who:

? Were employed by the Borrower at any point during the Covered Period whose principal place of residence is in the

United States; and

? Received compensation from the Borrower at an annualized rate of less than or equal to $100,000 for all pay periods in

2019 or were not employed by the Borrower at any point in 2019.

Employee's Name

Employee

Identifier

Cash Compensation

Average FTE

Salary / Hourly Wage

Reduction

FTE Reduction Exceptions:

Totals:

Box 1

Box 2

Box 3

Table 2: List employees who:

? Were employed by the Borrower at any point during the Covered Period whose principal place of residence is in the

United States; and

? Received compensation from the Borrower at an annualized rate of more than $100,000 for any pay period in 2019.

Employee's Name

Employee

Identifier

Totals:

Cash Compensation

Box 4

Average FTE

Box 5

Attach additional tables if additional rows as needed.

FTE Reduction Safe Harbor 2:

Step 1. Enter the borrower¡¯s total average FTE between February 15, 2020 and April 26, 2020. Follow the same method that

was used to calculate Average FTE in the PPP Schedule A Worksheet Tables. Sum across all employees and enter:

.

Step 2. Enter the borrower¡¯s total FTE in the Borrower¡¯s pay period inclusive of February 15, 2020. Follow the same method

that was used in step 1:

.

Step 3. If the entry for step 2 is greater than step 1, proceed to step 4. Otherwise, FTE Reduction Safe Harbor 2 is not

applicable and the Borrower must complete line 13 of PPP Schedule A by dividing line 12 by line 11 of that schedule.

Step 4. Enter the borrower¡¯s total FTE (a) for a PPP loan made before December 27, 2020, as of December 31, 2020 or (b) for a

PPP loan made after December 27, 2020, the last day of the covered period:

.

Step 5. If the entry for step 4 is greater than or equal to step 2, enter 1.0 on line 13 of PPP Schedule A; the FTE Reduction Safe

Harbor 2 has been satisfied. Otherwise, FTE Reduction Safe Harbor 2 does not apply and the Borrower must complete

line 13 of PPP Schedule A by dividing line 12 by line 11 of that schedule.

SBA Form 3508 (01/21)

Page 4

Paycheck Protection Program

Loan Forgiveness Application Form 3508 Revised January 19, 2021

OMB Control No.: 3245-0407

Expiration Date: 7/31/2021

PPP Borrower Demographic Information Form (Optional)

Instructions

1.

2.

3.

4.

5.

Purpose. Veteran/gender/race/ethnicity data is collected for program reporting purposes only.

Description. This form requests information about each of the Borrower¡¯s Principals. Add additional sheets if necessary.

Definition of Principal. The term ¡°Principal¡± means:

? For a self-employed individual, independent contractor, or a sole proprietor, the self-employed individual, independent

contractor, or sole proprietor.

? For a partnership, all general partners and all limited partners owning 20% or more of the equity of the Borrower, or any

partner that is involved in the management of the Borrower¡¯s business.

? For a corporation, all owners of 20% or more of the Borrower, and each officer and director.

? For a limited liability company, all members owning 20% or more of the Borrower, and each officer and director.

? Any individual hired by the Borrower to manage the day-to-day operations of the Borrower (¡°key employee¡±).

? Any trustor (if the Borrower is owned by a trust).

? For a nonprofit organization, the officers and directors of the Borrower.

Principal Name. Insert the full name of the Principal.

Position. Identify the Principal¡¯s position; for example, self-employed individual; independent contractor; sole proprietor;

general partner; owner; officer; director; member; or key employee.

Principal Name

Position

1=Non-Veteran; 2=Veteran; 3=Service-Disabled Veteran; 4=Spouse of Veteran; X=Not

Disclosed

Gender

M=Male; F=Female; X=Not Disclosed

Race (more than 1 1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native

may be selected) Hawaiian or Pacific Islander; 5=White; X=Not Disclosed

Ethnicity

H=Hispanic or Latino; N=Not Hispanic or Latino; X=Not Disclosed

Veteran

Disclosure is voluntary and will have no bearing on the loan forgiveness decision

Paperwork Reduction Act ¨C You are not required to respond to this collection of information unless it displays a currently valid OMB Control

Number. The estimated time for completing this application, including gathering data needed, is 180 minutes. Comments about this time or the

information requested should be sent to Small Business Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC

20416, and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC 20503. PLEASE DO

NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 3508 (01/21)

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